Provider Demographics
NPI:1346824992
Name:HOLM, TRINA DAWN (CNP)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:DAWN
Last Name:HOLM
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13538 CARDINAL RD NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-7835
Mailing Address - Country:US
Mailing Address - Phone:651-303-1921
Mailing Address - Fax:
Practice Address - Street 1:626 MINNESOTA AVE NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3037
Practice Address - Country:US
Practice Address - Phone:651-303-1921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8091363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily